Healthcare Provider Details

I. General information

NPI: 1427192277
Provider Name (Legal Business Name): KETTY HOVA-O'DONNELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 WILDWOOD DR
DIX HILLS NY
11746-6040
US

IV. Provider business mailing address

51 WILDWOOD DR
DIX HILLS NY
11746-6040
US

V. Phone/Fax

Practice location:
  • Phone: 631-643-6649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: